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How long for MAO-Is ?


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Since going off of Cymbalta, my psychiatrist has put me on Selegiline. Originally I was only going to go up to 10mg a day, because he normally doesn't prescribe MAO-Is to his patients, but I convinced him to bump me up to 15 mg a day. I am so used to how Cymbalta kicked in for me in like 2 weeks after I started taking it, that I'm kinda scared about MAO-Is because they don't work as fast. How long do I have to wait for any result from an MAO-I? Is it the typical 4-8 weeks?

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The first mao i was on was Marplan,i didn't notice anything for a long time,i am on nardil now after trying alot of the new drugs.

  It is really odd since it takes a long time and isn't instant relief  like boom wow i am not depressed.There may be some tingling in your fingers and a light feeling which goes away then stress reactions are easier to handle and the funkys sort of dissolve.I swear by the stuff but get check ups for blood pressure if you feel dizzy and too light.What works for me is they don't give that why bother feeling but kind of make depressing things get sorted out .You will know when the effect kicks in and it feels normal instead of electro chemical.

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but its not as powerful

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I'm sorry, but can you give me a reference of an unbiased study that states that Selegiline doesn't work as well as other antid's ? I saw one study that said that, but it was a 5 weeks study of 32 patients, and I believe it can take atleast 4 weeks for an effect of MAO-I to take place, so that study is invalid. Care to give a reference for that claim? I have access to a bunch of journals and what I have seen about Selegiline is that it can cause a great improvement in mood in bipolar I patients and Atypical depressed patients, at dosages below 15 mg.

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you're absolutely right, i have no study that says it isnt effective, but im not saying its not effective

its not really an antidepressant technically..  only prescribed off label, so either there is no interest in its approval or it hasnt really been shown to be "significantly" (whatever that means pfft) better than placebo or comparable to a TCA (the usual "ruler" of measurement) in a large study.  that being said, yes there are studies that show it is effective for some people, but for me it wasn't.  YMMV.. the people i do know who have been doing well on an MAOI are taking stuff like parnate or nardil, so i have no anecdotal evidence to contribute about selegiline except my own

do you have a reference for a larger study (32 people is way too unreliable) that was double blind controlled (with either placebo or a known effective antidepressant)?  id be interested to see how well it does in a big trial.

but its not as powerful

<{POST_SNAPBACK}>

I'm sorry, but can you give me a reference of an unbiased study that states that Selegiline doesn't work as well as other antid's ? I saw one study that said that, but it was a 5 weeks study of 32 patients, and I believe it can take atleast 4 weeks for an effect of MAO-I to take place, so that study is invalid. Care to give a reference for that claim? I have access to a bunch of journals and what I have seen about Selegiline is that it can cause a great improvement in mood in bipolar I patients and Atypical depressed patients, at dosages below 15 mg.

<{POST_SNAPBACK}>

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My experience with Parnate is that it worked very quickly. I was noticing a definate uplift in mood within two weeks -- especially in the suicidal thinking.

However, we also knew what dose had worked for me in the past and we went up very quickly (went from 0 to 120mg/day in those two weeks or so).

Fiona

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do you have a reference for a larger study (32 people is way too unreliable) that was double blind controlled (with either placebo or a known effective antidepressant)?  id be interested to see how well it does in a big trial

Yes I can give a reference, but its an journal and you need a membership. If you would like I can IM you the PDF, unless there is a way to post it here.

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do you have a reference for a larger study (32 people is way too unreliable) that was double blind controlled (with either placebo or a known effective antidepressant)?  id be interested to see how well it does in a big trial

Yes I can give a reference, but its an journal and you need a membership. If you would like I can IM you the PDF, unless there is a way to post it here.

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Sure that'd be cool.  The one thing I have seen mentioned in journals was that although selegiline does slightly increase dopamine levels, it increases levels of a brain chemical called phenylethylamine by about 1000%!  most of the other neurotransmitters can be metabolized by MAO-A, but this one in particular seems to only be metabolized by MAO-B.  The metabolites of selegiline are L-methamphetamine and L-amphetamine, which are weak stimulants, but at 15mg there is not very much of those in your system.

Because this an irreversible inhibitor of MAO-B (basically it murders your MAO-B hehe), it takes time to build up in your system and finish its murder spree (lol), but it also takes your brain like a month or so to get back to its normal level of MAO-B after you've reached that point, if you decide to discontinue the med.  So compared to drugs with long half lives (prozac for example), it almost acts like it's one of those, even though the drug itself has a fairly short half life.

It's too bad there isn't more information about selegiline on crazymeds, but there are lots of references elsewhere.

I'd definitely like to see that article, was it done in a general depressed population or patients with parkinsons?

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Yes I can give a reference, but its an journal and you need a membership. If you would like I can IM you the PDF, unless there is a way to post it here.

<{POST_SNAPBACK}>

You can post the reference here, even if it takes a membership to read the article. You can't, however, post the full text here -- although you can post excerpts and comments if you wish. (What you do in email or IM is something else completely.)

Fiona

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The article below, is about using low dose selegiline in the treatment of schizophrenia, I'm going to post more in a few minutes, a lot of them are case studies though which are unfortunatly not neccesarily demonstrative of the general population.

American Journal of Psychiatry, Feb 2005 v162 i2 p388(3)

Double-blind, placebo-controlled, multicenter trial of selegiline augmentation of antipsychotic medication to treat negative symptoms in outpatients with schizophrenia. (Author Abstract) J. Alexander Bodkin; Samuel G. Siris; Paul C. Bermanzohn; John Hennen; Jonathan O. Cole.

American Family Physician, Feb 1, 1995 v51 n2 p516(2)

Effectiveness of selegiline in depressed elderly patients. (adapted from the Archives of General Psychiatry, August 1994) (Tips from Other Journals)

Clin Neuropharmacol. 2005 July/August;28(4):191-192.

Remarkable Effect of Selegiline (L-Deprenyl), a Selective Monoamine Oxidase Type-B Inhibitor, in a Patient With Severe Refractory Depression: A Case Report.

Selegiline and other atypical monoamine oxidase inhibitors in depression

J Alexander Bodkin,  Anne E Kwon. Psychiatric Annals. Thorofare: Jun 2001.Vol.31, Iss. 6;  pg. 385, 7 pg

Also, on Remedyfind.com there are 3 REALLY good reviews on Selegiline for depression and I have done extensive emailing with all 3 of the people, in order to get a better understanding of it all. I figure its atleast worth a try.

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I still haven't gotten any type of reply as to how long MAO-I typically can take to have a full effect. Can someone please answer this?

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well selegiline really varies, because its an MAO-B inhibitor (read my post) so it doesnt have profound effect on serotonin, norepinephrine, dopamine levels, because these all can be alternately metabolized by MAO-A, which is supported by the data on levels of these neurotransmitters.  dopamine seems to prefer the MAO-B enzyme so you will get a kick up in that level, and phenylethylamine seems to be ONLY metabolized by that enzyme so you get like a 10x increase in that.  i'd imagine you'd get the full effect in 3 weeks tops, but there is no real data on it (that I have, at least).

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Does anyone know at which dose (s) it actually becomes an unselective MAO-A inhibitor? I have read a lot of different data, some that claim its 10mg, other that claim its 15mg, and yet others say its 20mg. My 'Drug Reference Guide 2004' says that dietary restrictions need to only be followed at dose (s) of < 15mg. So does anyone know a really credible reference for me to look at, so that I can put this question to rest? Please.

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Does anyone know at which dose (s) it actually becomes an unselective MAO-A inhibitor? I have read a lot of different data, some that claim its 10mg, other that claim its 15mg, and yet others say its 20mg. My 'Drug Reference Guide 2004' says that dietary restrictions need to only be followed at dose (s) of < 15mg. So does anyone know a really credible reference for me to look at, so that I can put this question to rest? Please.

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high dose... probably 20mg/day at least, but you are not getting nearly the action of a regular MAOI.  Of course I'm not an expert, but in order for it to "significantly" hit MAO-A, it would have to be a large dose like 20mg taken every day for like two weeks or so.. because all the prescribed doses recommended are highly MAO-B selective. 

ok here's a scientific journal article abstract quote, which suggests there is some MAO-A inhibition at even 10mg/day, due to significantly lower 5-HIAA recovered in the urine, but who knows what significant means (probably means measurable factoring in all possible error and consistently lower than normal):

"Urinary excretion of 5-HIAA (used as a marker for MAO-A inhibition) was unrelated to plasma concentrations of selegiline or DMS following single or repeat dosing of Zydis Selegiline 1.25 mg or conventional selegiline tablets 10 mg. However, comparison of treatment groups revealed a significantly lower excretion of 5-HIAA in the conventional selegiline tablets 10 mg group than in the Zydis Selegiline 1.25 mg group after repeated administration over 13 days."

BTW, 5-HIAA is a product of serotonin metabolism.  so less means less serotonin is being broken down.  but this guy Knoll (he has a lot of papers on selegiline) doesn't believe there is any significant MAO-A inhibition (which means something different than significantly lowered 5-HIAA levels) even at 20mg a day.

my wild-ass guess is that you're not going to get any _clinically_ important MAO-A inhibition at any dose a doctor would be willing to prescribe.  and if you did, you woul d have to carefully monitor your diet and follow the rules of a regular MAOI.

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I still haven't gotten any type of reply as to how long MAO-I typically can take to have a full effect. Can someone please answer this?

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Check above, I did give an answer to this for my experience. It will vary between people and meds, just as it does with every other med. MAOI's are generally quick acting meds.

Fiona

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